Provider Demographics
NPI:1225459860
Name:MARTY HOME CARE
Entity Type:Organization
Organization Name:MARTY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLETT
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:937-270-8455
Mailing Address - Street 1:5705 TERRACE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6047
Mailing Address - Country:US
Mailing Address - Phone:937-270-8455
Mailing Address - Fax:937-439-0530
Practice Address - Street 1:5705 TERRACE PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-6047
Practice Address - Country:US
Practice Address - Phone:937-270-8455
Practice Address - Fax:937-439-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 153487-M-IV251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care